Summary of First Four Prostate, Lung, Colorectal, and Ovarian Screening Roundsa continued...
Recruitment and randomization procedures differed among countries and were developed in accordance with national regulations. In Finland, Sweden, and Italy, the trial subjects were identified from population registries and were randomly assigned to the trials before written informed consent was provided. In the Netherlands, Belgium, Switzerland, and Spain, the target population was also identified from population lists, but when the men were invited to participate in the trial, only those who provided consent were randomly assigned.
In the screening group, 82% of men accepted at least one offer of screening. With 14 years of data, and a median follow-up of 9 years, there were 5,990 prostate cancers diagnosed in the screening group and 4,307 in the control group, corresponding to a cumulative incidence of 8.2% and 4.8%, respectively. There were 214 prostate-cancer deaths in the screening group and 326 prostate cancer deaths in the control group in the core age group. The unadjusted rate ratio for death from prostate cancer in the screening group was 0.80 (95% CI, 0.67–0.95); after adjustment for sequential testing with alpha spending due to two previous interim analyses (based on Poisson regression analysis), the rate ratio was 0.80 (95% CI, 0.65–0.98). The rates of death in the two study groups began to diverge after 7 to 8 years and continued to diverge further over time.
The absolute difference between the screening and control groups was 0.71 prostate-cancer deaths per 1,000 men. Thus, to prevent one prostate-cancer death, the number of men who would need to be screened would be 1,410. The additional prostate cancers diagnosed by screening resulted in an increase in cumulative incidence of 34 per 1,000 men, so that 48 additional subjects would need to be treated to prevent one death from prostate cancer. Thus, PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis.
Important information that was not reported includes the contamination rate in the control group, and the treatment administered to the prostate cancer cases by stage and by randomly assigned group. Incompleteness of data is also a concern because it appears that several of the participating countries have not yet provided data beyond the 10-year point at which the major effect appears to occur. Longer follow-up will be needed to determine the final results of this trial.